Parenting & New Baby Advice Blog

Archive for August, 2007

Expectations and Realities

For many expecting first time parents, the impending birth of their baby makes them acutely aware that they will never be simply a couple again, but that they are about to become a family. Other parents-to-be try to convince themselves that life will be unchanged after their child is born. This is not realistic. The birth of a child will bring with it multiple changes, both in the couple's relationship and in the reality of their activities and what they can plan, at least on a temporary basis. It is critical that a couple discuss these issues before their child is born. A couple who have convinced themselves that nothing will change will be in for a massive disappointment and many frustrations. The idea that they are in control of such a profound experience will be a disappointing fantasy once the baby is brought home from the hospital. On the other hand, the couple who have realistic expectations about the pregnancy and life with their newborn will enjoy the changes in their relationship as they become a family.

Infertility

About one in every five couples who want to conceive a child is unable to do so. During the last ten years or so, medical science has made tremendous progress  in diagnosing and treating causes of infertility and thus has given new hope to childless couples. Improved testing procedures, new drugs that simulate ovulation and surgical techniques that can correct males and female structural problems and sometimes successfully reverse sterilization procedures have enabled many couples to become parents.

Infertility is defined as a couple's inability to conceive a child after one year of regular sexual intercourse without birth control. In about forty percent of all cases of infertility, lies with the man, in about sixty percent, it lies with the woman or both partners.

Infertility is not sterility. The term infertility implies that the condition can be treated and reverse; sterility is applied to a permanent, irreversible inability to have children.

Causes of Male Infertility

One of the major causes of male infertility is low sperm count. The sperm count is determined by measuring the number of active sperm present in a millimeter [less than one half teaspoon] of semen [the fluid ejected from the penis during intercourse]. An average sperm count is ninety million sperm per millimeter; a count of forty to sixty million is thought to be necessary for conception. If a man's sperm count is less than twenty million it is highly unlikely that he will be able to father a child [although since only one sperm is needed to fertilize an egg, it is still possible].

A low sperm count can be caused by low levels of testosterone, the male sex hormone, by exposure to chemicals, pesticides or radiation, by very frequent sexual intercourse which depletes the sperm too quickly, and by heat [which slows sperm production] generated by wearing tight underwear or pants, sitting for long periods in cars or trucks, or working near ovens or kilns. Also, a man's fertility declines after the age of forty, although men can remain fertile into old age.

Infertility can also result if sperm cannot propel themselves through the female reproductive tract to reach the egg, or if sperm are irregularly shape [only sperm with oval heads can fertilize an egg].

In addition to problems with the sperm themselves, male infertility can be caused by any obstruction in the tubes that convey the sperm from the testes to the penis. Infertility may also be caused by varicose veins in the scrotum [the pouch containing the testes], perhaps because the increased blood flow in these swollen veins brings extra heat to the area, or by local infection or injury. Such infertility problems may often be reversed when the underlying condition is corrected.

Surgical removal of part of the prostate gland, as well as the use of certain drugs for high blood pressure can lead to retrograde ejaculation [a disorder in which the semen is passed backward into the bladder to exit with the urine, rather than out through the penis during ejaculation].

Another basic decision is choosing where you will give birth. Most women choose the hospital. Some give birth in freestanding birthing centers, or at home. Your decision on where to have your baby is made in much the same way you choose your care giver. You find out what is available and ask questions that are important to you.
The Hospital

If you prefer a hospital birth, the next question is which hospital? Most care-givers have privileges in one hospital, but some use more than one. Tour each of the hospitals your care-giver uses. It also may be useful to tour other hospitals-for comparison purposes, if nothing else. You might discover that you prefer a hospital where your care-giver does not have privileges. If so, and if you do not feel a strong tie to your care-giver, you might decide to change care-givers in order to use the facilities that appeal to you. If your community has more than one hospital, you might be surprised at how different they are from one another in their facilities, policies, and philosophies of care. Most hospitals offer tours of the maternity ward. You should call the hospital itself to sign up for a tour.

What do you look for when touring a hospital? First of all, observe the atmosphere. Many hospitals have attractive private labor rooms and bathroom facilities. What provisions are there for the mother's comfort? Some have very comfortable labor beds, while others have very narrow, hard labor beds. Some provide nice touches like rocking chairs, couches where the partner can rest, showers and tubs to use for pain relief, and beanbag chairs for getting into comfortable positions. Others make no provisions at all for the comfort of mother or father.

Does the hospital have birthing rooms [attractively decorated rooms where the mother can labor, give birth, and spend time with her newborn afterward? In some hospitals, the birthing room is the only room the mother will be in throughout her entire hospital stay. In others, she labors and gives birth in the birthing room, and then goes to a postpartum room for one, two, or three days before going home. In still other facilities, she labors in one room, is moved when she is about to deliver, may go to another room to recover and then goes to still another room for the rest of her hospital stay. Currently, many hospitals are beginning to convert their maternity facilities so that a woman can labor, deliver and recover in the same room. [A so-called L.D.R. room].
Check the nursery. What does it look like? Are the mothers encouraged to keep their babies with them in their rooms, or do the babies spend most of their time in the nursery? Do the nurses seem friendly and warm? What about the person leading the tour? Is she friendly and does she answer your questions, or is she simply herding you through brusquely? [Some hospitals are so busy that they don't take potential clients on a tour of the actual facilities. In place of a tour there will sometimes be a slideshow and discussion of policies and procedures with a member of the staff.].

Ask some specific questions about admitting procedures. Ask to see the general consent forms that require your signature when you arrive at the hospital. Be sure to read these in advance and clarify any questions you may have. It is certainly not easy to read consent forms carefully if you are already in labor.

Questions about hospital procedures need to be carefully worded. For example, if you ask," What usually happens to the baby after he or she is born?" you will learn more than if you ask, "What is the hospital's procedure for routine newborn care?" There are few hospital policies on these kinds of things, but there certainly are customs, and those are what you want to know about. You may ask for a step-by-step description of what usually happens after a woman in labor arrives. Do most women have a nurse assigned to them, or do the nurses take care of more than one laboring woman at a time? Are they understaffed sometimes, and what do they do if this happens? Do women usually receive pain medications, or do many women use little or no pain medications? If a women desire to have an unmedicated childbirth, is she actively encouraged and supported in this by the nurse? Do most women receive intravenous fluids, continuous electronic fetal monitoring, and rupture of the membranes, oxytocin and episiotomies? Does the hospital have a high rate of cesarean births? Ask how cesareans usually done [for example, what type if anesthetic is usually used, and is the father encouraged to be present?] Can a woman have a vaginal birth after a previous cesarean? How long is the usual hospital stay? Is there a short-stay or early-discharge program that allows mothers and babies to go home within a few hours after birth? Does the hospital provide any kind of follow up?

Clarify the costs of labor and delivery rooms, nursery charges, postpartum care, and so forth. You also, of course, will want to check your insurance policy, if you have one, to see how much you have to pay.
Out of Hospital Births

If you are considering giving birth outside the hospital, find out what services are available in your community. Are there competent people offering home-birth care? Is there a licensed birthing center in your area?

Out-of-hospital birth is a choice only for women who are in good health and who have had normal pregnancies. Interventions are often not necessary for healthy women having normal labors, but if the need arises, the woman is transferred to the hospital. Those planning out-of-hospital births, therefore expect to labor without pain medication and without medical intervention. It must be remembered that the care-givers in out-of-hospital settings have fewer facilities [and possibly less skill] should emergency situations arise. Minutes count. How long will it take to receive adequate care?

Many women, of course, are not comfortable giving birth away from emergency medical facilities available in hospitals. This disadvantage of out-of-hospital births should be carefully considered by all women contemplating birth outside the hospital.

One problem that keeps coming up in patient-physician relations is communication. Physicians are busy people and one of the most common complaints about them is that they are always rushed and do not have the time to answer and discuss questions. Sometimes the physician is not even present; the office nurse is the one who sees the woman if the physician is tied up at the hospital. Poor communications and misunderstandings lead to depersonalized and sometime unsatisfactory care. There are solutions to this problem. One is to seek a care-giver who is not so busy [physicians who are just starting a practice often have more time] or who schedules appointments long enough to get to know each woman. Midwives are such care-givers, but they are few in number. Some established physicians also plan more time for individual appointments. Another solution, which has many other advantages, is the birth plan. What is a birth plan and why is it worthwhile? A birth plan is simply a written description of your priorities and preferred options during labor and birth, and afterward. The plan may be placed in your chart, where it can be read and consulted by those involved in your care. The portion that pertains to your baby [the baby care plan] can be placed in the baby's chart and is separate from your own.

A birth plan has many advantages. Simply preparing a birth plan helps you focus your learning on the various options [for example, natural versus medicated childbirth, circumcision versus no circumcision, and breast versus bottle feeding]. It encourages you and your partner to discus your worries and expectations and to come to an agreement on what is important. During labor of course, the benefit of the birth plan is that you do not have to take the time and trouble to tell each staff member your wishes on every option as it comes up.

Birth plans also help your care-giver. If you prepare a rough draft and go over it with your care-giver, he or she will know you better and will know how to help you in labor. He or she can also help you modify options that may seem unwise or inappropriate. Potential misunderstandings can be detected in advance so that neither of you is caught by surprise when the stress of labor makes discussion difficult. Your care-giver may be willing to initial your plan, indicating to hospital staff that he or she agrees with it. It is not a legal agreement or a contract. It is simply a statement of your wishes.

For the nursing staff and other people who will be caring for you during labor, the birth plan makes you less of a stranger to them. It is a shortcut to communications and lets you know what is important to you and how they can help.

Your birth plan should be flexible, taking into account not only a normal, or "textbook" labor, but also the possibility of a difficult labor, complications, or other unexpected events.

Your birth plan might begin with a brief paragraph describing yourself and anything that you feel would help the staff understand you better and to understand your birth plan. For example, if you had a long period of infertility before your pregnancy, if you have had miscarriages in the past, or if you previously experienced a tragedy associated with childbirth, it will help for the staff to know that. If you have a fear of hospitals or medications, or if you have had unpleasant experiences in hospitals in the past, tell them. If a natural birth is extremely important to you, let them know so that they can offer you maximum support in that effort. If avoidance of pain is a high priority, let them know. If you have religious preferences, if yours is a blended family with other children, if you have impaired hearing or vision, if this has been a particularly difficult pregnancy-knowing these things will help the staff meet your needs. You might simply want to state that you will appreciate their help, advice, and expertise.

The next section of the birth plan is a straightforward list of your preferences for a normal labor and birth. Include only item that you care about. You do not have to hold an opinion on everything. At the moment, you may feel you do not have enough background to decide your preferences on these procedures. Childbirth classes and discussions with your care-giver will give you the needed information.

If your labor is prolonged and more painful than expected, if the baby isn't tolerating labor, or if you develop complications that make intervention necessary, your ideal birth plan may have to change. Let it reflect a recognition that these things can happen and that you are flexible enough to be able to accept changes in the plan if they are necessary to your sake or your baby's.

Sometimes a cesarean birth becomes necessary for any number of reasons. It helps to acknowledge the possibility of a cesarean birth in your birth plan, and indicate your preferences if it does indeed happen to you. For example, you might state that you prefer to remain awake, to have your husband present, or to touch and nurse your baby as soon as possible after the surgery.

Adolescent needs are special during pregnancy because her diet must supply the calories and nutrients necessary to meet her own growth needs as well as her baby's. Teenagers would benefit from individualized nutritional counseling aimed at meeting their nutritional requirements and matched to their lifestyles.

Multiple Pregnancies

If you are expecting two or more babies, you should consume more calories and nutrients. Seek the advice of your doctor or a registered dietitian.

Caffeine

Caffeine is a substance naturally found in coffee, tea, cola drinks, and chocolate. It may also be found in some medications. Careful label reading will alert you to its presence.

Caffeine readily finds its way to the fetus, and the concentration of caffeine in fetal blood will be about the same as the level in maternal blood. Studies have not shown an association between caffeine consumption and fetal abnormalities, but it is known that caffeine is a powerful stimulant. Caffeine also increases the production of stress hormones, causing constriction of uterine blood vessels, which lessens the blood flow to the uterus and temporarily decreases the amount of oxygen reaching the fetus.

Large amounts of caffeine cannot be good for your baby or you, since this substance has not been proved safe for the developing baby, little or no caffeine consumption during pregnancy are wise.

Artificial Sweeteners

Little is known about the long term safety of non sugar sweeteners, such as saccharin. And aspartame [NutraSweet is the trade name for aspartame]. Saccharin has been associated with bladder cancer and no one is sure about the long term effects on the baby or early intra-uterine exposure to saccharin. NutraSweet has not been proved unsafe, but there are no long term studies that show it is safe for the developing fetus. Probably the best advice is to consume these products in moderation or to avoid them altogether.

Herbal Teas

Some herbs and herbal teas contain drugs. Ginseng tea contains a small amount of estrogen. Chamomile tea contains ragweed which can cause severe allergic reactions in some people. Teas made from juniper berries may cause stomach irritation. Just because the herbal teas are considered to be "natural" does not mean they are safe for pregnant women expecting babies. You might check with your doctor or pharmacist about particular herbs before you take them.

A good activity to begin during pregnancy is a walking program designed for expectant mothers, three to five days/week. Walking is an inexpensive form of exercise, as the only requirements are a suitable pair of shoes and comfortable clothing. Also, it is an activity that can be readily integrated into daily schedules. During pregnancy, you can improve your aerobic fitness by walking on level ground at a comfortable pace. However, it may be necessary to use modified forms of walking to gain significant benefits. Walking at increased speeds, up and down hills, and while carrying weights can raise the heart rate to levels that will improve aerobic fitness.

*Remember. Walk with your pulse in your target heart rate zone. Never exercise to exhaustion. End your workout at the point of which you feel you could go on for another ten minutes.

The Cool Down

Once you stimulate your circulation and complete your twelve minute workout, slow down your activity gradually, over a five minute period. Before you actually sit down [or begin strengthening exercises] your pulse should be below your target zone of 110 bpm or lower. Then stretch again for five minutes [ten minutes is even better], and you're done! You will feel warm, full of energy, and virtuous.

Strengthening Exercises

Strengthening exercises, or calisthenics, can be fun as well as beneficial when done to music. They tone, strengthen, and increase your muscle mass to help you perform better in physical activity and look glowing in pregnancy and sleek after delivery. The exercises that follow will strengthen all muscle groups.

Cautions

During pregnancy, do not perform an exercise that calls for you to lie on your back for more than one minute. If repetitions are not complete in one minute by the clock, go to the next exercise and then come back to the previous exercise to complete repetitions.

When a pregnant woman is lying on her back, the uterus [with the weight of the baby] presses on the vena cava, a large blood vessel directly behind the uterus. This pressure decreases blood flow to the lower part of the body and inhibits returning blood flow to the upper body and heart blood flow [and therefore oxygen supply] to the pelvic region, where baby growth is in progress, is decreased. Blood pressure drops, while the pulse increases. In early pregnancy, these changes may be slight and barely noticed by the mother. After the fourth month, however, these changes are more pronounced. Even if the mother does not experience symptoms or if the symptoms are not strongly felt, the physical changes still occur, compromising the well-being and physical and mental health of the growing baby.

Symptoms range from a feeling of vague discomfort to shortness of breath, dizziness, anxiety and even fainting. All symptoms can be relieved [and avoided] by turning on the side, especially the left side, which allows the uterus to roll completely off the vena cava.

Lying on your back should be avoided except for one minute by the clock, to perform abdominal exercises. If you choose not to lie on your back at all, exercise the abdominal muscles by using the Pelvic Rock on All Fours and Sit-Backs exercises. These are not as efficient for strengthening the abdominal muscles, but will still allow you to exercise them while avoiding the supine position.

Situations other than exercise may also cause the vena cava to be compressed. Try to sleep on your side at night, and avoid flopping back in chairs and propping yourself up on an angle when sitting on the floor.

Remember, before beginning any exercise program, it is important to check with your doctor.